BACKGROUND:
The Texas Legislature recently passed a provision allowing for a conscientious exemption to vaccination. Since 1971, Texas has allowed both medical and religious exemptions to vaccination.

OBJECTIVE:
To examine the trends in the percentage of school-aged children with medical or religious exemptions on file attending public schools in Texas.

METHOD:
Data on exemptions by vaccine were analyzed from the Annual Report of Immunization Status in Texas Schools. This is a self-reported survey conducted by the Texas Department of Health (TDH) Immunization Division that is administered annually to Texas public school districts and accredited private schools. The survey collects aggregate data on immunization status of students. Data from the 1997 to 2002 surveys were analyzed for the total number and percentage of students enrolled in public school with medical or religious exemptions by vaccine.

RESULT:
The number of Texas students enrolled in public school with either a medical or religious exemption is small. However, the average percentage of Texas students with these exemptions rose over the time period under study (1997 – 2002), from an estimated 0.10% of students in 1997 with either a medical or religious exemption to one or more vaccines to 0.23% of students in 2002.

CONCLUSION:
The estimated percentage of Texas students with a medical or religious exemption to vaccination has risen over the time period from 1997 to 2002. Medical exemptions for the varicella vaccine account for most of the increase in the number of students with exemptions. The varicella vaccine requirement was implemented in 2000. It is unknown at this time how the new conscientious exemption will affect the total number of exemptions being claimed for students in Texas.

LEARNING OBJECTIVES:
To learn about exemption trends in Texas and the possible reasons behind the increase.